N BUDESONIDE X CLDP

 A

Here is a table summarizing the use of budesonide in chronic lung disease of prematurity (CLD/BPD) based on current evidence:

Aspect	Details
Indication	Prevention and management of bronchopulmonary dysplasia (BPD)/CLD in preterm infants139.
Target Population	- Preterm infants on respiratory support, especially <32 weeks gestation1. - Infants <25 weeks: consider if on any respiratory support1. - Infants 25–32 weeks: if requiring supplemental oxygen1.
Route of Administration	- Inhaled (nebulized) budesonide17. - Intratracheal instillation with surfactant as a vehicle (in some protocols)249.
Timing	- Early administration (within first 24 hours or when evolving BPD is evident)1310.
Duration	Continue until the baby is in air for 1–2 weeks or comes off high-flow respiratory support; decision individualized1.
Efficacy	- Reduces incidence of BPD (risk ratio ~0.61–0.79)169. - Reduces duration of mechanical ventilation, oxygen requirement, and hospital stay69. - Some studies show improved lung function at 2 years3.
Safety	- No significant increase in short-term adverse events in most studies9. - Some trials (e.g., NEUROSIS) reported a possible increase in mortality with very early use in extremely preterm infants10.
Special Notes	- Benefits may be greater in infants >28 weeks or >1000g birth weight9. - Evidence certainty is mostly low to moderate; further large-scale studies needed9. - Should be part of a broader strategy including early surfactant and non-invasive ventilation1.

Key Points:

• Budesonide, especially when combined with surfactant or given via inhalation, can reduce the risk and severity of BPD in preterm infants.

• Clinical judgment is essential in selecting candidates and determining duration.

• Potential risks, especially in the most immature infants, should be weighed against benefits10.

“Budesonide is continued until the baby has been in air for 1-2 weeks or comes off the High Flow. The decision to stop is a clinical one. … latest meta-analysis data … shows no significant change in mortality and a RR of BPD of 0.79 … A 20% reduction in risk of BPD is significant.”1

“PS with budesonide reduced bronchopulmonary dysplasia (BPD) incidence (risk ratio, 0.61), duration of mechanical or invasive mechanical ventilation, duration requiring oxygen, and hospitalization time in preterm infants, without short-term adverse drug events. … Only moderate-to-severe BPD or severe BPD showed a significant reduction when PS was used in conjunction with budesonide, a finding supported by moderate evidence certainty.”9

“In a large trial (NEUROSIS) … inhaled budesonide … the incidence of bronchopulmonary dysplasia was lower but a significant increase in mortality was also reported in the budesonide group.”10

If you need a more detailed breakdown (e.g., dosing, administration technique), please specify.

1. https://ashfordstpeters.net/Guidelines_Neonatal/Chronic%20Lung%20Disease%20Aug%202022.pdf
2. http://ww.omjournal.org/articleDetails.aspx?coType=1&aId=2957
3. https://pubmed.ncbi.nlm.nih.gov/32119192/
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC11717239/
5. https://www.sciencedirect.com/science/article/abs/pii/S2590041224000138
6. https://d197for5662m48.cloudfront.net/documents/publicationstatus/66142/preprint_pdf/f4389c51904b60c84fb32065d552730c.pdf
7. https://pmc.ncbi.nlm.nih.gov/articles/PMC5843959/
8. https://www.anmfonline.org/wp-content/uploads/2022/05/Budesonide_ANMFv1.0_20220505-1.pdf
9. https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0312561
10. https://www.ijpediatrics.com/index.php/ijcp/article/download/4353/2825/16577